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1990, 11-01 Permit App: 90005854 Woodstove
MECHANICAL PERMIT APPLICATION FORM 685'/ �I n Information Worksheet ' JOB STREET ADDRESS: Lane/ / V QO(ne /�P.(nnefl Ro �/ �� Z CITY/STATE/ZIP:Sp Lane/\NH-Cj�('a1Q PARCEL NUMBER: ?act- OWNER: \jetHne, je rVital/��Day I d PHONE NUMBER: lac —s 9r; c&) 9av/� MAILING ADDRESS: / v (.)(to /3th/l eV1 J?/XLL 104riz e fry M 99c,/ (Street)`�/�� (City/State) (Zip) )�n Lc� r i � P crW LICENSE NUMBER: / 11 }'/,%J C /ci i �,�1 PHONE NUMBER: 53.S - / ✓73 City/State) (Zip) CONTRACTOR: MAILING ADDRESS: EI as S / rtrvF (Street). MECHANICAL.WORKSHEET/FEE:.SCHEDULE ..-; DESCRIPTION NUMBER X EACH - • :OF UNITS, 's ttNrr AMOUNT; DUCTWORKiSYSTEM • WOODSTOVE/INSERT GAS,LWATER•HEATER _ _ HEATING:,EQUIPMENT <100,(300 <_, HEATING;'EQUIPMENT' +100, 000 BTU':; ; is r GAS PIPING:-(EA'•OUTLET)'._ - i:IREFRIG4+100M BTU . (NOT, A/C OR_ HEAT. PUMP),,,: ;%REFRIG;';501•=1; 000M'. BTU >?:REFRIG,-^`t',,001-1,.750M BTU_;•^ REFRIG7+1;75014.BTU '' ';-_ HEAT;r'PUMP,;;;& AIR;7,CONDITIONER HEAT.': PUMP; &:;'AIR'CONDITIONER HEATPUMP;:&'`AIR,:CONDITIONER HEATPUNP:& AIR' CONDITIONER .HEAT' PUMP•:&:AIR•CONDITIONER VENTILATING FANS' 3-15 ,TONS',#;c!_£'• '157;301.;TONS»,', 30=50:, TONS +50TONS .' EVAPORATIVE'COOLERS TYPE I'%HOOD .(PER 12' OR 12' PTN: TYPE II,HOOD OF HOOD) CLOTHES DRYER RANGE `.. • GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE) UNLISTED GAS APPLIANCE <400,000 BTU UNLISTED GAS APPLIANCE >400,000 BTU USED APPLIANCE <400,000 BTU USED APPLIANCE >400,000 BTU_ _ AIR HANDLER <10,000 CFM AIR HANDLER >10,000 CFM • .beau; i'!r :-:•Ir;i. fj.:(.'• x$10:00',= x 25..00 x 10.00'= x 12'.00 x: 15:00'=. x's(,1.00 = x,z 12.00 x 20.00,,E= x'• x,35.00,= x;; 60.00 x?12?00'1 x;s`2000'1= x 25:'001 x'35:00'.. x'60.001 x 10.00 = x•10.00•= x 50.00.= x.10.00 = x 10.00= x 10.00"= x 10.00 = x 10.00 = x 50.00 = x100.00'= x.50.00 = x100.00 = x 12.00 = x 15.00 = NOTE:7717 UM PERMIT FEE IS $35.00 SIGNATURE V• CJU pp' - SUBTOTAL $ c;S,b() PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ °" Spokane County Department of Building and Safety West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675